Standard Consent Form

Standard Consent Form

South Rhea Animal Hospital | 865 Rhea County Hwy | Dayton, TN 37321
Thank you for giving us the opportunity to care for your pet(s). In order to maintain accurate records, we ask that you complete all of the following information.
Your Name*

First NameLast Name
Pet(s) Name*

Pet(s) Name
Phone Number*
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
As owner or agent of the above -mentioned animal, I hereby give my consent to South Rhea Animal Hospital to perform the following procedures:

List procedures:
I understand that during the performance of these procedures, unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth above. I expect South Rhea Animal Hospital to use reasonable care and judgement in performing the procedure(s). The nature of the procedure and risks involved have been explained to me and I realize results cannot be guaranteed. I am also aware that unforeseen events resulting from the procedures will not relieve me from any obligation to all reasonable costs incurred regarding the animal.

ALL ANIMALS ADMITTED MUST BE CURRENT ON A RABIES VACCINE AND MUST BE FREE OF EXTERNAL PARASITES. ANY ANIMAL FOUND TO HAVE FLEAS OR TICKS WILL BE TREATED AT THE OWNERS EXPENSE.
Signature of Owner/Agent*

Clear
Date*

MonthDayYear
Date
Signature of Witness/Tech

Clear
Date

MonthDayYear
Date
Should be Empty: